Duration of systemic corticosteroids in the treatment of asthma exacerbation; a randomized study

Objective To determine an appropriate duration for a short course of oral steroids in cases of asthma exacerbations. Setting A 1,000 bed city hospital in Kobe, Japan. Patients Patients with asthma exacerbations who needed hospital admission. Methods Following an initial treatment with a 3-day course of intravenous methylprednisolone, patients were allocated to either a 1-week (1 W) or a 2-week (2 W) course of oral prednisolone (PSL, 0.5 mg/kg), Outcome measures Peak expiratory flow rate (PEF) and rate of unscheduled hospital visits and readmission. Results Twenty patients were enrolled (10 in 1 W, 10 in 2 W), Mean PEF just before starting oral PSL in 1 W and 2 W were 51 and 58% of each patient's best value. PEF was significantly improved and to a similar degree over the course of time in both 1 W and 2 W. The frequency of unexpected hospital visits during a 3-month period after discharge was similar (2 in 1W and 2 in 2 W), No readmission occurred during the same period, Conclusions Because both the 1-week and the 2-week course of oral PSL were equally effective in the treatment of asthma exacerbations, 1 week may be appropriate as the maximum duration of a short rescue course of oral steroids.